Tag Archives: oral surgeon

An interesting turn of events

21 Apr

Just fifty-four weeks after services were rendered, Blue Cross Blue Shield of Massachusetts (BCBS) has issued payment for my jaw surgery. They paid quite a good sum of money, too. They actually issued a check directly to my father, who is the subscriber for the policy, in the amount of $2976, which is what they determined their liability to be. That’s about $1000 more than I’ve paid to the oral surgeon.

Presumably what happens from here is that my other insurance plan will learn that they’ve overpaid and request that the oral surgeon return some amount of their money. I’ll then have to send the oral surgeon a check for that amount.

It wasn’t so long ago that I wondered whether my time spent on the phone with BCBS would save me any money at all. For a while, they were telling me that SHIP had already paid more than they would have paid. Between that and SHIP’s non-duplication of benefits policy, it seemed like I might have already hit a ceiling for the combined payments of those two insurers.

With this development, though, I’ll save roughly $1200, even if SHIP decides that they shouldn’t have paid anything. Needless to say, I’m pretty happy right now.

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Caving in

31 Mar

I’ve finally caved and payed my oral surgeon bill in full. I’m hoping insurance will eventually pay a bit more, but I didn’t feel like pushing things any further with the oral surgeon’s office. It had been quite a long time.

In other news, Monday will mark a year from the date of my accident. I’m planning to take another trip back to the site of my accident this weekend. I’m hoping that I’ll find the pavement has been repaired, but perhaps that’s too optimistic.

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Bills

28 Feb

By the time fall came around, I had assumed that my insurance had paid all of my bills since I hadn’t received any more. It turns out that I was wrong; they were just very slow to reject a couple of claims. Specifically, my parents’ insurance has rejected claims from Berkeley Emergency Medical Group and the oral surgeon.

The balance with Berkeley Emergency Medical Group was only $76.30, but I haven’t gotten a bill from them yet. The oral surgeon’s bill is much bigger, nearly $2,000, because it was out-of-network for both of my insurances. The oral surgeon’s office also seems to be in a bigger hurry to get money from me. I’ve received a bill from them as well as a couple of phone calls.

The billing person at the oral surgeon’s office told me that my claim was rejected because of a non-duplication of benefits policy. However, when I called the insurance company, they seemed to be telling me that they had rejected my claim simply because they didn’t know anything about my other insurance and thus couldn’t determine how much they should pay. So I gave them the information for my other insurance, and they told me that they’d take 30-45 business days to figure things out and then process the claims again. That was about 26 business days ago, so I’ll call them again at the end of this week.

I also authorized a partial payment to the oral surgeon’s office, since I don’t want that balance turned over to a collections agency. The oral surgeon’s office seems thoroughly confused about this situation, and I really think they underestimate how much my insurance will owe. This is, after all, my primary insurance, but the oral surgeon’s office billed the other one first.

I’ve started to wonder why I was referred to this oral surgeon from the emergency room if it was out-of-network for my insurance. One possibility is that it was because the emergency room had my insurance information wrong, initially billing Blue Shield of California instead of any insurer with which I actually had a policy. Next time I talk to the oral surgeon, I’ll ask if they’re in network for Blue Shield of California. Of course, it’s also entirely possible that the emergency room just doesn’t have a policy of referring within network.

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Apples

4 Jul

When the oral surgeon took my arch bars out, he told me that I’d be able to resume eating the hardest foods “some time around the fourth of July.” Obviously that was an approximate date, but it seemed as good a day as any, so yesterday I acquired a bag of eight Royal Gala apples. Originally, I was planning on saving them for breakfast, but I got hungry around midnight, so I ate one at about 12:05AM and another a few minutes later. I had another one for breakfast, and just finished another one a few minutes ago. So far, I haven’t had serious problems with my jaw, although with the first couple there was some pain on the right side (opposite the fracture). My repaired teeth also seem to have handled it fine.

In other news, I took a ride back to the scene of my accident this morning. I’ll write about my visit as soon as I can, but there’s actually quite a bit to say about it, so the post might not make it up for a day or two.

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Eleven week billing update

22 Jun

I decided to consolidate billing-related posts into a weekly digest from now on. I’d like to be able to say that it’s because I’m too busy to write a new post every time a bill comes, but that would be a lie. The only reason I can offer is that I was tired of thinking of titles for posts about billing.

With that said, here’s what’s happened in the last week.

  • I received a statement from my oral surgeon. It was dated June 10, which was the day I had the arch bars removed. It was addressed to my father, but at my address, apparently a result of confusion over the fact that one of my insurance policies is through my father. The statement said that I had a balance of $1,963.18 which was “Due Now.” This number is apparently the $1,888.18 for the surgery left unpaid by the UC Berkeley insurance plus a $75 fee for the office consultation the day after the accident. I had expected my second insurance plan to pay something, so I was a little bit surprised to see the whole amount due now. The statement also stated that interest of 18% per year would be charged after 60 days and that my entire balance was 61-90 days old. This latter measurement apparently began from the date of service rather than the date of billing.I called the office of the oral surgeon to see if they had billed the second insurance company. I was told that they had, that I would receive another statement after the insurance had paid, and that no interest would be charged until then. The statement I received was apparently “just an updated statement,” which apparently means I can ignore the part about the balance being due now.
  • I also received a letter from Meridian Resource Company, LLC, on behalf of Anthem Blue Cross seeking to determine whether somebody else may be liable for some of the charges from the oral surgeon’s office. The only way I can imagine that this would be the case is if the road condition were such that the City of Oakland were liable, but I doubt that this is the case.
  • I still have a bill from Bay Imaging Consultants for $53.79. They seem to have not billed my father’s insurance, so I should get them to do so. I’ve been lazy about it, though, because the bill doesn’t have a due date.

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Loose ends, Part I

16 Jun

With my recovery nearly complete, my posts here will be less frequent than they once were. I’ll still be posting about billing and insurance when there’s news on that front. I’ll also post updates on any new developments with my injuries if and when things arise. Eventually, I’ll get around to posting about some of the things I’ve learned from my accident and its aftermath (including a guide for those who are recovering from similar injuries) and how my experiences have influenced my worldview.

In the mean time, there are a few things that I probably should have mentioned a while ago. I’ll post three here. I may include more in subsequent posts.

  • Some time after I returned from my oral surgery, I found an x-ray of my mouth among the things that I had carried home from the surgeon’s office. I have never had any recollection of the taking of the x-ray, but it was apparently done after I had my mouth wired, as the wires are visible. Here it is. Note that the left side of my mouth (with the fracture) appears on the right side of the image.
    x-ray
  • It seems that I’ve neglected to explain that the part of my jaw that I broke, the condyle (or maybe it was the neck of the condyloid process, just below the condyle) is located near the joint with the upper jaw, rather than near the teeth. I suspect that this made the recovery easier than it otherwise might have been because the pictures of jaws broken between the teeth look far more gruesome than anything I saw on my own face.
  • A few days after the oral surgeon wired my mouth shut, my mother mentioned to me that she had read that people who have their jaws wired shut often have to carry wire cutters for emergency use. I had no recollection of the oral surgeon saying anything to me about wire cutters, but I could not rule out the possibility that he had said something but I could not remember because I was still feeling the anesthesia. Furthermore, some research showed that my mother’s claim was correct. Moreover, I discovered a few days before my wireless upgrade that the instructions I received from the hospital said,

    If your jaw was wired shut, it is important that you be able to open the wires in any emergency that makes it difficult to breathe, such as vomiting, extreme coughing or choking. Therefore, you must carry a pair of small wire-cutters with you at all times. Be sure you know which wires to cut in case this is necessary. If not, ask your doctor.

    To be clear, this came from the hospital, and I had my jaw wired a few days later by an oral surgeon at a different practice. But I never carried a wire cutter. I’m still alive today. Go figure.

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Good enough

12 Jun

I went in to the oral surgeon’s office today expecting to learn some new jaw exercises. In view of my recent reading, I was somewhat skeptical of the idea that my opening was actually going to get better, so I showed up prepared to ask whether it was reasonable to

When the oral surgeon came into the examination room, he asked me how my opening was. I started to answer before he clarified that he wanted to see it. I opened my mouth, and to my surprise, he told me that it was better than he expected. He added that most people can put three fingers in their mouth, and then demonstrated by trying to put three of his fingers in his mouth. The third one didn’t really fit, though. He had me try to do the same, and I was able to put two fingers in easily, but my opening wasn’t wide enough for a third finger.  The oral surgeon said it was close enough,  demonstrated with his fingers that it was only a millimeter or two from normal, and then watched as I opened and closed my mouth a couple of times to make sure that it was opening straight. He said that I “totally qualify” to have my braces taken off and asked if I wanted them removed right then. I wanted little more, so I answered in the affirmative.

The oral surgeon told me that the wires around my teeth would poke my gums as he pulled them out, so he gave me three options for counteracting the pain: nitrous oxide and a numbing gel; nitrous oxide, the numbing gel, and  novacaine; or general anesthesia. I chose the first of these options, and the oral surgeon told me that most people can handle it, adding that it was “like having a really mean hygienist.”

The oral surgeon moved me to another room, where an assistant put gauze in my mouth, spread the numbing gel on my gums, and hooked me up with nitrous oxide through my nose. The oral surgeon came into the room and started to say, “The adventure that began in April…”. He said it in this overly dramatic tone that sounded like it might have come from one of Barack Obama’s speeches (video; see 9:44), but the second half of the oral surgeon’s sentence, “…comes to a close,” was decidedly less dramatic. He then took the gauze out of my mouth, told me to open my mouth, and cut each of the wires on the top of my mouth before pulling them out. It hurt a little bit, but the pain went away when the wire was out, so it wasn’t bad. At this point, I realized that I had actually started breathing through my mouth again, and I wasn’t feeling the nitrous oxide as much. The oral surgeon then removed the bottom wires. Somewhere in the middle of removing the bottom wires, I noticed that I was sweating a lot, but I don’t know if this was nervousness, an effect of the numbing agents, or a result of the room actually being hot.

The oral surgeon turned off the nitrous oxide and turned on a supply of oxygen, and told me that I didn’t need to return to his office, but I could call if I had concerns. He added that I’d be ready to chew the hardest foods (which he identified as crisp apples, hard French bread, and very hard vegetables) around July 4. The assistant gave me a toothpaste and toothbrush and had me brush my teeth. I had brushed before going, so there wasn’t anything but blood on them, but I complied anyway. The assistant told me that my gums would bleed easily for the next two or three weeks, but that I shouldn’t let this keep me from flossing.

Finally, I have some pictures. First up is a picture of my mouth, sans arch bars.

open mouth

It isn’t perfectly straight, but the appearance of crookedness is exaggerated by the fact that my front teeth are not the same length. The second picture is of me trying to stuff my fingers in my mouth.

I tried to stick my fingers in my mouth before I got caught by the vegan police.

I tried to stick my fingers in my mouth. I suppose this endeavor was made slightly easier by the fact of my having slender fingers.

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Bills and such

10 Jun

I’ve been out of town for a bit, and I returned home this morning to find some billing-related materials waiting for me.

The only actual bill came from Bay Imaging Consultants Medical Group. as far as I can tell, this has something to do with the x-rays I received in the hospital. This is apparently separate from the radiology item on my statement from the hospital. The bill lists charges for three items: “ORTHOPANTOGRAM”, “SHOULDER COMPLETE”, “FACIAL BONES, COMPL., MINIMUM”. The total charges were $147, but payments from my insurance brought it down to $53.79. The bill doesn’t say, but I’m pretty sure (based on my memory of some paper which I think I have in a big stack somewhere) that those payments come from my UC Berkeley SHIP plan, rather than my parents’ plan (which is supposed to be my primary insurance). I’ll have to give them a call to see if I can get them to bill the other insurer for the remainder.

I also received an explanation of benefits from the university insurance plan for my services from the oral surgeon. The insurance was billed for $3,720, of which $3,200 was for the surgery and $520 was for anesthesia. The insurance company has covered $1,831.82, and they expect me to pay $1,888.18. Of this amount that I’m responsible for, $146.21 is applied to my deductible, $457.95 is my coinsurance responsibility, and $1,284.02 “exceeds the allowed expense and is the member’s responsibility to pay.” For the record, I don’t really understand what all of these words mean, but maybe some day I’ll find out.

I’m hoping that the oral surgeon’s office will bill the remaining balance to my other insurance. I shouldn’t need to remind them about my second insurance, seeing as they called me for information about it while I was still sleeping off the anesthesia from the surgery.

The last related document I received was an explanation of dental benefits from MetLife, which provides my dental benefits for the SHIP plan. This was for the repairs of the chipped teeth. The statement tells me that the fee for my services is ordinarily $372, but the dentist agreed to accept only $286 as part of his participation in Metlife’s Preferred Dentist Program. Metlife reports having paid $208.80, leaving me to pay $77.20. As I understand it, they are applying $25 to my deductible and then paying 80% of what’s left. I’ll have to ask the dentist if they are also billing my parents’ dental insurance. Either that or I will just wait until I have a bill before I do anything.

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Some pessimism

6 Jun

Several weeks ago, I saved a copy of a review on the treatment of condylar fractures to my hard drive. More specifically, the paper attempts to address the question of whether open treatment (surgery involving an incision) or closed treatment (such as the treatment used in my case) of these injuries is better. I wasn’t looking for an answer to this specific question in the article; my oral surgeon mentioned open treatment only as something that would be used if the closed treatment failed.

It was only today that I actually got around to reading the review. I was glad that I wasn’t reading it to find out whether open or closed treatments are better because the findings were inconclusive. Nonetheless, I did learn some interesting things from it. I was particularly interested in one of the findings of a study of Ellis and Throckmorton:

The patients whose condylar process fractures were treated by closed methods had significantly shorter posterior facial and ramus heights on the side of the injury, and more tilting of the occlusal and bigonial planes toward the fractured side, than patients whose fractures were treated by open methods.

I’m unfamiliar with many of the words in there, but to the extent that I understand the sentence, I think that it might confirm what I have suspected: that the asymmetretry in my mouth’s opening may be related to the way in which my bones have healed, and not just a result of stiffness in the muscles. In particular, the ramus is a part of the mandible, and apparently it is sometimes shorter after a condylar fracture has occured. This isn’t actually something that is of particular concern to me, but I do wish that my oral surgeon had acknowledged it to me.

Other studies found that patients with closed treatment experienced chronic pain and malocclusion (misalignment of the teeth), neither of which I’ve experienced since treatment.

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Twenty-three with braces

2 Jun

These days, the only major sign of my accident is the arch bars on my teeth. The oral surgeon told me that they’d stay on until my mouth is opening normally enough that he is sure they won’t be needed again. As the days progress, I find myself increasingly impatient for this to happen. I don’t particularly mind the look, and the arch bars aren’t even that visible. It’s just that I feel like I’m about ten years too old to have braces on my teeth.

Over the last week or so, I’ve been stretching my jaw muscles more and more. The oral surgeon only told me I should work on opening wider, but sometimes I work on the side-to-side motions a bit, hoping that it might help to correct the problem of the right side of my mouth opening further than the left.

The truth is that I don’t even really know how far my mouth should be able to open, or even what straight is. The latter question seems like it should be easily settled, but it’s not so easy because my front teeth aren’t perfectly straight. Some of them have shifted slightly since the accident (owing to my inability to wear a retainer while my jaw was wired), and two were chipped and then repaired artificially. The oral surgeon wants me to focus on keeping my chin straight, but even that’s not so easy because my chin has a small bump on the right side where it was stitched up. As for the width of the opening, I haven’t been able to find out what is normal, but I’m pretty sure that it’s wider than my opening of about four centimeters.

If there’s one thing that keeps me from sitting around and exercising my jaw all day long, it’s the understanding that my trying too hard to fit in may well have caused the accident in the first place. I’m not quite sure what could go wrong here. I doubt that my muscles are strong enough to break the bone again, but I’d rather not find out.

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